Pre- and Probiotics, Thinking Outside the Gut

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It’s commonly known that prebiotics and probiotics are essential to maintaining a healthy gut. Recently, more and more studies are emerging that display the correlation between gut and brain health.

Kara Landau, CEO and dietitian at Uplift Food and nutrition advisor to the Global Prebiotic Association, says that gut health plays a large role in supporting mood and this is why she created Uplift Food. “When we consume prebiotics, the probiotics naturally found inside of us are able to ferment these nutrients, with a key by-product of the fermentation process being short chain fatty acids (SCFA),” says Landau. She explains that this process releases the neurotransmitter serotonin and anti-inflammatory cytokines, both of which reduce stress signals to the brain.

“Considering mental health issues are starting to be understood as not merely a hormone deficiency, but rather also a result of internal inflammation, it makes sense to support our bodies with an anti-inflammatory diet, of which prebiotics, and probiotics, are one part,” states Landau.

WholeFoods columnist Jaqui Karr, CGP, CSN, CVD adds that “An unhealthy gut leads to compromised brain function, including neuropsychiatric issues from depression to dementia. These are degenerative issues, which means they usually start small and grow.” Karr says that gut health is integral to normalizing brain function and overall mood. Along with a healthy diet and lifestyle, prebiotics and probiotics can drastically improve gut and therefore overall health.

The term “psychobiotics” refers to a class of probiotics that have the potential to support mental health (1). They are being studied for a range of conditions, including more severe depression, to those with low-mood or stress. Probiotics can accomplish this through a few pathways. One potential way probiotics can affect mental health is through the ability to produce active compounds with neurological functions, such as neurotransmitters.

“There are several hormones and metabolites that are produced by probiotics that affect the brain and mood, compounds like serotonin, dopamine, brain-derived neurotropic factor, GABA and even short-chain fatty acids,” explains Kiran Krishnan, microbiologist for Just Thrive Probiotic, based in Park Ridge, IL.

“There are several hormones and metabolites that are produced by probiotics that affect the brain and mood; compounds like serotonin, dopamine, brain-derived neurotropic factor, GABA and even short-chain fatty acids.”

For example, gamma-aminobutyric acid (GABA), serotonin, catecholamines and acetylcholine can be produced in the gut and when secreted in the gut may trigger cells in the gut’s lining that send signals to the brain (1).

Psychobiotics may also modulate stress response in the HPA-axis, which becomes dysregulated when subjected to chronic stress. One animal study published in Neurogastroenterology and Motility found that mice pretreated with a probiotic formulation saw attenuation in HPA-axis and autonomic nervous system activity (2). This suggests that probiotics “modulate neuroregulatory factors and various signaling pathways in the central nervous system involved in stress response,” write the researchers.

Yet another way probiotics may support mental health is by supporting a healthy inflammatory response. This is important because chronic inflammation in the body and brain has been identified as a major underlying cause of depression and other mental health conditions (1). Unfortunately, this inflammation can often begin in the gut since disruption of the gut microbiota can lead to pathogenesis of GI disease as well as inflammatory bowel disorder (3). These bacterial pathogens even activate sensory neurons that induce inflammation and pain.

Bacteria that are being studied as psychobiotics include Lactobacillus helveticus and Bifidobacterium longum (used in the animal study mentioned previously), Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus plantarum and Bifidobacterium bifidum for depression and anxiety (1). For stress, researchers are looking at Lactobacillus casei and Lactobacillus helveticus.

Prebiotics can also regulate mood and brain function by decreasing cortisol which is a stress hormone (1). Fructooligosaccharides and galactooligosaccharides have been shown in research to significantly reduce morning cortisol levels and the latter has been associated with reduced anxiety in irritable bowel syndrome sufferers (1).

Maximum Efficacy
“Prebiotics and probiotics are known as symbiotics and work most effectively together,” explains Landau. “Ideally a combination of prebiotic soluble fibers, prebiotic resistant starches and insoluble fibers are consumed together to ensure the prebiotic nutrients make their way to the distal parts of the colon to fully impart their benefits.”

Efficacy can also be affected by when a probiotic is taken. Karr describes a study that found “probiotics maintained their highest numbers when taken with fat, with meals, or up to 30 minutes before meals that included fat. Probiotics taken 30 minutes after meals had the lowest survival rates.”

Immune Health
The link between gut health and immune health has been a hot topic in recent studies. Landau says, “Our gut health plays a vital role in immune health. Supporting reductions in inflammation via gut supportive nutrients is definitely an important factor in supporting our immune system.”

Deerland Enzymes published a whitepaper exploring the connection between sports nutrition/immune health and probiotics. It states that 70% of our immune cells are located in the digestive tract (4). Athletes, for example, are more prone to bacterial and viral infections for 72 hours after training because of changes in antibodies that suppress the immune system. According to the firm, their DE111 Probiotic can support the immune system by helping the gut barrier, preventing the adhesion of pathogens to the gut wall (4). Not only can probiotics help with immune health, but they also aid recovery from workouts and muscle development.

“A compromised gut is a Pandora’s Box, with no way to tell what will happen.”

Karr says that supplements and prebiotics can definitely help immune health, if used properly. She suggests working with a qualified practitioner and creating a custom plan to take the right combination for each individual. “Most clients I’ve seen were taking several supplements that weren’t helpful or necessary to their issues, and they were completely unaware of the supplements that did help them tremendously, sometimes eliminating symptoms in a few short days,” Karr explains.

“The right prebiotic that has been clinically shown to increase good groups of bacteria, can be very powerful for immune health. Bacteria control our immune system and the right bacteria can have a profound effect on how our immune systems respond to infection,” says Krishnan. “Thus, a prebiotic that can feed and help grow key bacterial groups can be a big help to the immune system.” He suggests carefully selecting a prebiotic that will not feed the bad bacteria along with the good, by targeting a specific one rather than being too general. Krishnan suggests taking clinically validated precision probiotics that have been shown to increase certain key bacterial families.

Larry Robinson, Ph.D., VP of scientific affairs at Embria Health Sciences, believes the most researched role of the gut microbiome outside of digestion is how it affects immune health. Many companies have begun to study the effects of ingredients on immune health. He says Embria took the opposite route. “In fact, the development of our ingredient EpiCor fermentate was inspired by the discovery that an animal feed fermentation ingredient strengthened factory workers’ immune systems exposed to the products,” says Robinson. These immune benefits led to research into the digestive realm. “EpiCor has been proven to provide prebiotic benefits at a low 500 mg daily dose while significantly reducing bloating,” he continues. “This beneficial shift in the gut microbiome may possibly explain EpiCor’s clinically shown ability to promote regularity by significantly improving stools and reducing gut discomfort.” Other studies with EpiCor have shown significant digestive health benefits as well as respiratory health and healthy pollen response.

Other Benefits
Recent studies are showing a greater range of benefits from prebiotics and probiotics beyond even immune and brain health/mood. Landau shares that pre- and probiotics can help maintain healthy blood sugar levels because they make our cells more responsive to insulin and can help enhance satiety.

Research shows that spore-based probiotics can even help heal leaky gut, which has been shown to be a cause of diseases like heart disease and diabetes. Leaky gut syndrome, or metabolic endotoxemia, is when the small intestine lining becomes damaged and toxins from the gut enter the bloodstream. “There are particle endotoxins called LPS, lipopolysaccharide. When this lipopolysaccharide leaks into your circulatory system from your gut, it starts the process that leads to diabetes, heart disease and so on,” says Krishnan. “The American Diabetes Association is studying LPS quite intensely because they now know LPS moving into the circulatory system is the start of Type II diabetes.”

In a clinical study conducted by Just Thrive Probiotic, 75 subjects with leaky gut syndrome were either given spore-forming Bacillus strains or placebo for 30 days (5). Results showed that after 30 days those participants taking spore-forming Bacillus strains saw a 42% reduction in endotoxin and a 24% reduction in triglycerides as well as a significant reduction in pro-inflammatory cytokines potentially reflecting a reduction in systemic inflammation.

Krishnan notes that no other lifestyle or dietary habits were changed during the study. Leaky gut is also believed to be a driving force behind autoimmunity and inflammatory bowel disease. The participants taking the spore saw reduction in immune activation, while those on the placebo actually got worse just within the 30-day study (5).

Certain strains of bacteria can aid in weight loss by preventing absorption of fat in the intestine and increasing satiety, therefore burning more calories and storing less fat. In a study of women aiming to lose weight, participants took Lactobacillus rhamnosus for 3 months and lost 50% more weight than those not using a probiotic (6). Lactobacillus gasseri was also used in a weight loss study and participants saw an 8.5% reduction of belly fat. Caution should be exercised because not all strains can lead to weight loss. In fact, strains like Lactobacillus acidophilus have been shown to lead to weight gain (6).

Krishnan adds that certain strains can help skin conditions like acne, improve oral health and gum disease and urogenital health (yeast infections, UTIs, etc). “Another thing that LPS affects dramatically is skin,” says Krishnan. “We are doing an acne study at the University of California Davis, Integrative Dermatology Department. The research already exists that shows leakiness of the gut, the inflammation that comes along with it, affects the types of bacteria that live on your skin and also affects the type of sebum that you have.”

Karr adds that it is a health blunder to only look at the body as separate parts. She says we really need to look at the body as a whole, and recent studies with gut health are starting to do this. “I’ve been reviewing a study about gluten antibodies creating such a harmful state that they can be measured in the spinal cord. Antibodies in the spinal cord fluid can create severe issues that would affect nerve function, motor movement, and more,” observes Karr. “A large part of that is a compromised gut and toxins being able to cross barriers they should never cross. A healthy gut can improve all areas of health and probiotics can help do so. A compromised gut is a Pandora’s Box, with no way to tell what will happen.”

What to Watch Out For
Landau introduces an interesting point that looking for sufficient doses of prebiotics in supplements is important. She suggests looking for “products from credible brands that actually offer gut health nutrients in doses that offer a significant benefit.” Some brands or products only use a small amount, so they can market as a prebiotic, rather than using an amount backed by science for sufficient results.

Robinson agrees and says, “Without a doubt, products need to be formulated with a sufficiently appropriate dose to provide the intended health benefit. Anything less is misleading.” Probiotic supplements can be great for overall health, it’s just important for consumers to be educated on what to look out for.
Food products including probiotic powders are trendy but Landau warns that not all products are created equal and some may be unhealthy and made from refined carbs or sugars with inflammatory properties.

That is why it’s important to vet products which utilize ingredients that have proven efficacy. Manufacturing a food or beverage product with a probiotic strain is difficult because one must ensure its survival through the manufacturing process. That’s why it’s important to work with ingredients that have proven efficacy. Certain Bacillus coagulans strains such as Ganeden BC30 and Sabinsa’s Lactospore have been subjected to clinical studies demonstrating their ability to survive the manufacturing process and populate the digestive tract.

For example, one randomized, double-blind, placebo-controlled trial published in the Journal of Nutrition, studied the effect of BC30 on the immune health of 36 men and women ages 65—80 (7). Results showed that the subject given the probiotic strain had increased populations of the beneficial bacteria Faecalibacterium prausnitzii as well as an increase in anti-inflammatory cytokines, demonstrating its ability to support the immune health of aging individuals who are susceptible to disease.

Shaheen Majeed, president, Sabinsa Worldwide, based in East Windsor, NJ, explains that Bacillus coagulans produce lactic acid which has the potential to improve the nutritional value of food, control intestinal infections and improve the digestion of lactose. In one in vivo model, Lactospore demonstrated a significant effect on phagocytosis and an ability to regulate cholesterol and blood sugar levels, when combined with their proprietary cinnamon extract (8).

Karr observes that we have become a society plagued by “Magic Pill Syndrome” and that supplements are not a one-size-fits-all approach. She says our food choices are the biggest key in our health. Gut health is so important for the rest of the body and can be improved through healthy food choices, boosted by probiotics or supplements. WF

References
1. Kathleen Jade, MD, “The Best Probiotics for Mood: Psychobiotics May Enhance the Gut-Brain Conncetion,” https://universityhealthnews.com/daily/depression/the-best-probiotics-for-mood-enhancing-the-gut-brain-connection-with-psychobiotics/
2. A. Ait-Belgnaoui et al. “Probiotic gut effect prevents the chronic psychological stress-induced brain activity abnormality in mice.” Neurogastroenterology and Motility. 26(4):510-20. 2014.
3. P.I. Anastasia et al. “Gut-microbiota-brain axis and effect on neuropsychiatric disorders with suspected immune dysregulation.” Clinical Therapeutics. 37(5): 984–995. 2015. https://www.
ncbi.nlm.nih.gov/pmc/articles/PMC4458706/
4. Deerland Enzymes, “Whitepaper: Probiotics for Sports Nutrition,” http://www.deerlandenzymes.com/marketbreakdown/
whitepaper-probiotics-sports-nutrition/
5. B.K. McFarlin et al. “ Oral spore-based probiotic supplementation was associated with reduced incidence of post-prandial dietary endotoxin, triglycerides, and disease risk biomarkers.” World Journal of Gastrointestinal Pathophysiology. 8(3): 117-126. 2017.
6. Healthline, “8 Health Benefits of Probiotics,” https://www.
healthline.com/nutrition/8-health-benefits-of-probiotics
7. E.P. Nyangale, et al. “Bacillus coagulans GBI-30, 6086 Modulates Faecalibacterium prausnitzii in Older Men and Women.” Journal of Nutrition. 2015.
8. Vaclav and Jana. “Physiological effects of a combination of Cinnulin with probiotics.” American Journal of Immunology. 9(94):103-109. 2013.

Published in WholeFoods Magazine June 2018

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